CLINICAL RESEARCH: CLINICAL INSIGHTS FROM CARDIAC IMAGING
Left Ventricular Non-Compaction
Insights From Cardiovascular Magnetic Resonance Imaging
Steffen E. Petersen, MD*, ,
Joseph B. Selvanayagam, MBBS, FRACP*,,
Frank Wiesmann, MD*,,
Matthew D. Robson, PhD*,,
Jane M. Francis, DCRR, DNM*,,
Robert H. Anderson, MD, FRCPath ,
Hugh Watkins, MD, PhD, FRCP and
Stefan Neubauer, MD, FRCP*,,*
* University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
Cardiac Unit, Institute of Child Health, University College London, London, United Kingdom
Manuscript received October 25, 2004;
revised manuscript received February 9, 2005,
accepted March 10, 2005.
* Reprint requests and correspondence: Dr. Stefan Neubauer, University of Oxford Centre for Clinical Magnetic Resonance Research, University Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom (Email: stefan.neubauer{at}cardiovascular-medicine.ox.ac.uk).
OBJECTIVES: We aimed to test the diagnostic accuracy of cardiovascular magnetic resonance (CMR) imaging in distinguishing pathological left ventricular non-compaction (LVNC) from lesser degrees of trabecular layering seen in healthy volunteers and, in those with cardiomyopathies and concentric left ventricular hypertrophy, potential differential diagnoses. We hypothesized that pathological trabeculation could be distinguished by determining the ratio of non-compacted to compacted myocardium (NC/C ratio).
BACKGROUND: Left ventricular non-compaction is characterized by a non-compacted myocardial layer in the left ventricle. Cardiovascular magnetic resonance images this layer with unprecedented quality, particularly in the ventricular apex, where echocardiography has inherent difficulties.
METHODS: We analyzed magnetic resonance cine images, using the 17-segment model in 45 healthy volunteers, 25 athletes, 39 patients with hypertrophic cardiomyopathy and 14 with dilated cardiomyopathy, 17 with hypertensive heart disease, and 30 with aortic stenosis, as well as images from 7 patients previously diagnosed with LVNC whose diagnoses were supported by additional features.
RESULTS: Areas of non-compaction were common and occurred more frequently in all groups studied in apical and lateral, rather than in basal or septal, segments. A NC/C ratio of >2.3 in diastole distinguished pathological non-compaction, with values for sensitivity, specificity, and positive and negative predictions of 86%, 99%, 75%, and 99%, respectively.
CONCLUSIONS: Left ventricular non-compaction is diagnosed accurately with CMR using the NC/C ratio in diastole.
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Abbreviations and Acronyms
| | CMR = cardiovascular magnetic resonance | | DCM = dilated cardiomyopathy | | LV = left ventricle/ventricular | | LVNC = left ventricular non-compaction | | NC/C ratio = ratio of non-compacted to compacted myocardium |
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